Azelnidipine reduces urinary protein excretion and urinary liver-type fatty acid binding protein in patients with hypertensive chronic kidney disease

BACKGROUND: Hypoxia plays a significant role in the pathogenesis and progression of chronic renal disease. Urinary liver-type fatty acid binding protein (L-FABP) levels reflect the clinical prognosis of chronic renal disease. The calcium channel blocker azelnidipine has anti-oxidative properties and these may contribute to the beneficial effects of this drug. The aim of the present study was to determine whether azelnidipine and/or amlodipine affected urinary protein excretion or the urinary levels of 8-OHdG and L-FABP in hypertensive patients with mild chronic kidney disease (CKD). METHODS: Thirty moderately hypertensive chronic kidney disease patients were randomly assigned to 2 treatment groups: azelnidipine 16 mg once daily or amlodipine 5 mg once daily. Treatment was continued for 6 months. Urinary protein excretion and urinary levels of 8-OHdG and urinary L-FABP were measured before 3 and 6 months after the treatment period. RESULTS: Both drugs exhibited comparable and significant effects on the systolic and diastolic blood pressure. Azelnidipine decreased heart rate significantly after 3 and 6 months whereas amlodipine increased it significantly after 3 and 6 months. Urinary protein excretion, urinary 8-OHdG and urinary L-FABP levels decreased significantly after 3 months (p < 0.05) and 6 months (p < 0.05) in the azelnidipine group. In contrast, amlodipine showed little effect on urinary protein excretion or the urinary levels of 8-OHdG and L-FABP throughout the experimental period. CONCLUSIONS: Azelnidipine is renoprotective in hypertensive patients with mild CKD and this action is, at least in part, due to the anti-oxidative effect.     

肝型脂肪酸结合蛋白研究进展

肝型脂肪酸结合蛋白(liver type fatty acid binding protein,L-FABP)是脂肪酸结合蛋白家族的重要成员,主要在肝脏、小肠及肾脏表达.既往研究其主要与机体脂肪酸的吸收及转运、细胞内的长链脂肪酸的转运及细胞器内的再分布等密切相关.近年发现肝型脂肪酸结合蛋白具有信号转导分子的功能,是机体能量代谢的重要环节,进一步的研究证明与酒精性、非酒精性脂肪肝损伤、肾间质损害、糖尿病、器官缺血损伤等密切相关.鉴于其小的分子量及良好的细胞膜通透性,有望成为较好的肝、肾组织损伤的敏感指标.本文就近年肝型脂肪酸结合蛋白的生理功能、调控机制以及临床应用进展作一综述.     

心型脂肪酸结合蛋白在急性冠脉综合征患者中的变化及其临床意义

目的探讨心型脂肪酸结合蛋白(H-FABP)在急性冠脉综合征(ACS)患者中的变化及其临床意义。方法冠心病患者110例并行冠脉造影证实,其中急性心肌梗死(AMI)35例、不稳定型心绞痛(UAP)45例,稳定型心绞痛30例。采用双抗体夹心ELISA法定量测量待测血清HFABP、Myo、cTn和CK-MB浓度,根据美国心脏病协会所规定的冠状动脉血管图像记分分段评价标准,对病变狭窄程度进行分度,累及血管支数计算;用卡方检验分析血HFABP、Myo和cTnI以及CK-MB与患者冠状动脉狭窄程度、病变支数的相关性。结果 AMI患者H-FABP、CK-MB、MYO、cTnI较健康体检者、稳定型心绞痛和不稳定型心绞痛患者显著增高(P<0.01),UAP患者H-FABP也较SAP患者升高(P<0.01),无论是胸痛发生3小时前还是3小时之后,H-FABP的阳性率均比Myo和CK-MB以及cTnI敏感性更高(P<0.01)。在ACS患者H-FABP无论在发病3小时之前还是之后均较Myo和cTnI以及CK-MB更早出现(P<0.05)。ACS患者H-FABP的水平与冠脉狭窄程度及病变支数明显相关,即双支病变和多支病变高于单支病变,重度狭窄高于中度和轻度狭窄病变(P<0.05)。ACS患者的心脏射血分数(EF值)小于40%的H-FABP水平要高于EF大于40%的H-FABP水平(P<0.05)。结论 H-FABP对ACS的诊断较Myo、CK-MB和cTnI更敏感。H-FABP、Myo、cTnI以及CK-MB的联合检测与ACS的患者冠状动脉病变严重程度呈正相关,H-FABP与冠脉病变程度相关程度更高。血清H-FABP、Myo、cTnI以及CK-MB升高是冠状动脉病变加重的结果。     

Prognostic significance of heart fatty acid binding protein in patients with non-ST elevation acute coronary syndrome: results of follow-up for twelve months

Value of heart fatty acid binding protein (FABP) for medium term prognosis in patients with non-ST elevation acute coronary syndrome (NSTEACS) is not well established. AIM: To compare prognostic value of FABP levels with those of troponin I (TnI) and creatine kinase MB (CK MB) activity in patients with NSTEACS. METHODS: Serum FABP and TnI levels (HyTest), CK MB activity (Biocon) were measured in 203 patients with NSTEACS (mean age 63.9+/-11.5 years, 52.2% male). Blood was sampled at admission within 12 (median 3.83) hours and in 6 and 12 hours after onset of pain. Upper limits of normal range (ULN) for TnI and CK MB were 0.4 ng/ml and 25 U/l, respectively. Serum FABP was measured in 53 healthy volunteers (mean age 44.3+/-13.3) and 95th percentile was used as ULN (4.67 ng/ml). Deaths and nonfatal MIs (events) were registered during one year follow-up. RESULTS: There were 47 events (23%, 23 deaths and 24 nonfatal MIs). Patients with events compared with those without events had significantly higher TnI and CK MB 12 hours after onset of pain and significantly higher FABP at all time points of blood sampling. Multivariate (step-up) analysis selected the following independent predictors of events: elevated FABP 6 hours after pain onset (OR 2.45, 95% CI 1.14-5.24; p=0.021), T-wave inversion on admission ECG, age >65 and regular use of nitrates before hospitalization. Sensitivity of elevated FABP 6 hours after pain onset was 78.4%, specificity -- 45.1%. After exclusion from analysis of all or just admission and 6 hours FABP data elevated TnI 12 hours after onset of pain became an independent predictor of events. CONCLUSION: In this group of patients with NSTEACS among markers of myocardial necrosis (FABP, TnI, MB CK) obtained serially during first 12 hours after pain onset elevated FABP was the best predictor of events during 1 year follow up for subjects in whom blood sample could be done 6 hours after pain onset.     

心型脂肪酸结合蛋白与急性冠脉综合征患者冠状动脉病变程度的关系

目的探讨心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)与近期发作急性冠脉综合征患者的冠状动脉病变严重程度的相关性及原因分析。方法入选暨南大学医学院附属第四医院急性冠脉综合征(发作12 h内)患者168例,其中急性心肌梗死86例、不稳定型心绞痛82例。采用双抗体夹心酶联免疫吸附试验(ELISA)法检测血清H-FABP、肌钙蛋白(cardiac troponin T,CTnT)及肌酸磷酸激酶同工酶(creatine phosphokinase isoenzyme,CK-MB)浓度。采用Gensini积分系统对冠状动脉血管病变狭窄程度、病变部位及范围进行定量评定。比较急性心肌梗死组与不稳定型心绞痛组血清H-FABP浓度及冠状动脉病变Gensini积分;比较Gensini积分、冠状动脉狭窄程度、病变支数亚组之间H-FABP浓度;采用直线回归分析方法分析血清H-FABP浓度与冠状动脉病变严重程度、血清cTnT浓度、血清CK-MB浓度的相关性。结果急性心肌梗死组血清H-FABP浓度显著高于不稳定型心绞痛组,差异有统计学意义[(88.5±32.9)pg/mL vs.(14.3±5.4)pg/mL,P<0.01]。随着冠状动脉狭窄程度加重、累及支数增加及Gensini积分增加,血清H-FABP浓度显著升高,差异有统计学意义(P<0.05)。血清H-FABP浓度与cTnT(r=0.627,P<0.05)及CK-MB(r=0.530,P<0.05)具有相关性;与患者冠状动脉病变严重程度呈正相关(r=0.538,P<0.01),其相关系数高于cTnT与冠状动脉病变严重程度的相关性(r=0.385,P<0.05)。结论血清H-FABP浓度升高反映了冠状动脉病变严重程度,临床可根据血清H-FABP浓度升高推断冠状动脉病变的严重程度,并采取积极的治疗措施。     

高敏C-反应蛋白与白介素-6在急性冠状动脉综合征意义

目的 探讨急性冠状动脉综合征(acute coronary symptom,ACS)病人血清高敏C反应蛋白(high sensitivity-C reactive protein,hs-CRP)和白介素-6(interleukin-6,IL-6)浓度的变化及临床意义.方法 ACS组ACS病人60例,稳定型心绞痛(stable angina pectoris,SAP)组病人40例,对照组为40名健康人,检测血清IL-6、hs-CRP水平.结果 ACS组血清IL-6、hs-CRP水平明显高于SAP组和对照组(P＜0.01);ACS组中,急性心肌梗死病人又高于不稳定型心绞痛病人(P＜0.05);SAP组与对照组差异无统计学意义(P＜0.05);血清IL-6和hs-CRP水平呈正相关(r=0.5942,P＜0.01).结论 ACS病人血清IL-6和hs-CRP升高,其水平变化反映ACS的严重程度.     

急性冠状动脉综合征患者血清基质金属蛋白酶-9水平变化及意义

目的探讨急性冠状动脉综合征(ACS)患者血清基质金属蛋白酶-9(MMP-9)水平的变化及其临床意义。方法采用酶联免疫分析(ELISA)方法,测定ACS患者、稳定型心绞痛(SAP)患者和健康对照组血清MMP-9水平的变化。结果三组MMP-9分别为(284.30±64.60)ng/ml;(169.80±35.20)ng/ml;(164.40±33.80)ng/ml。三组间比较差异有显著性意义(P<0.001),三组间两两比较,ACS组与SAP组和对照组比较差异有显著性意义(P均<0.001),而SAP组和对照组比较差异无显著性意义(P=0.922)。按SAP、不稳定型心绞痛到急性心肌梗死由轻到重的等级排列,发现MMP-9由低到高的顺序排列,MMP-9水平与冠心病事件的严重程度呈正相关(r=0.762,P<0.001)。结论冠心病患者血清MMP-9水平增高可作为ACS的一个危险信号,同时也可以作为冠心病患者危险分层的一个重要生化监测指标。     

Heart fatty acid binding protein in patients with ST-elevation acute coronary syndrome hospitalized within 6 hours after onset of pain

AIM: To compare diagnostic value of a novel marker of myocardial necrosis heart fatty acid binding protein (FABP) with that of troponin I (TnI) and total creatine kinase (CK) in patients admitted early after onset of ST-elevation acute coronary syndrome. MATERIAL: Fifty seven patients with ST-segment elevations justifying thrombolytic therapy admitted within 6 hours (29/57 within 3 and 12/57 - 2 hours) after onset of chest pain. In all patients myocardial infarction (MI) was eventually confirmed by development of Q waves and/or diagnostic increase of CK. METHODS: Samples of blood were taken at admission to coronary care unit. Cut-off values for an elevated level of FABP was 12 ng/ml, TnI - 1.2 and 0.4 ng/ml, CK - 400 IU/l. RESULTS: Overall FABP was elevated in 47 (83%), TnI - in 16 (28.1%), CK in 7 (12.3%) patients. Among patients admitted within first 3 and 2 hours FABP was elevated in 23/29 (79.3%) and 11/12 (91%), TnI - in 9/29 (31%) and 5/12 (41.7%), CK in 3/29 (10.3%) and 1/12 (8.3%) patients, respectively. The use of lower cut-off of abnormality (0.4 ng/ml) increased proportion of patients with elevated TnI up to 56.1% in the group as a whole, to 48.3% and 50% among patients admitted within first 3 and 2 hours, respectively. Nevertheless proportion of patients with elevated FABP remained higher with difference being significant for the whole group and patients admitted within first 3 hours (p=0.004 and 0.016, respectively). CONCLUSION: Most patients with ST-elevation acute coronary syndrome hospitalized within 2-6 hours after onset of pain had elevated levels of heart FABP.     

Effect of pioglitazone on urinary liver-type fatty acid-binding protein concentrations in diabetes patients with microalbuminuria

BACKGROUND: Urinary liver-type fatty acid-binding protein (L-FABP) is a useful marker for renal tubulointerstitial injury. Pioglitazone is reported to be effective in early diabetic nephropathy. The aim of the present study was to determine whether pioglitazone affects urinary L-FABP levels in diabetic nephropathy patients with microalbuminuria. METHODS: Sixty-eight patients with type 2 diabetes and microalbuminuria were randomized to a 12-month treatment with pioglitazone (30 mg/d, n = 17), glibenclamide (5 mg/d, n = 18), voglibose (0.6 mg/d, n = 17), or nateglinide (270 mg/d, n = 16). Pre- and posttreatment urinary albumin excretion (UAE) and urinary L-FABP concentrations were compared between the four treatment groups and 40 age-matched healthy subjects. RESULTS: Pretreatment UAE and urinary L-FABP levels differed little between the four groups. UAE and urinary L-FABP levels were significantly greater in the diabetes patients than in the healthy subjects (UAE: p < 0.001; L-FABP: p < 0.01). After 6 and 12 months, UAE and urinary L-FABP were significantly lower in the pioglitazone treatment group than in the other treatment groups (UAE: 6 months, p < 0.01 and 12 months, p < 0.001; L-FABP: 6 months, p < 0.05 and 12 months, p < 0.01). CONCLUSIONS: Pioglitazone, but not glibenclamide, voglibose, or nateglinide, appears to be effective in reducing UAE and the urinary L-FABP level, suggesting that pioglitazone has a specific role in ameliorating both glomerular and tubulointerstitial lesions associated with early diabetic nephropathy.     

Beneficial effects of olmesartan and temocapril on urinary liver-type fatty acid-binding protein levels in normotensive patients with immunoglobin A nephropathy

BACKGROUND: Liver-type fatty acid-binding protein (L-FABP) is a clinical biomarker of tubulointerstitial damage, which plays an essential role in the progression of chronic kidney disease (CKD), including immunoglobin A (IgA) nephropathy. The effect of combination therapy with the angiotensin receptor blocker (ARB) and the angiotensin-converting enzyme inhibitor (ACEI) on CKD has not been elucidated. METHODS: Twenty-four normotensive patients with IgA nephropathy were randomly assigned to receive olmesartan 10 mg/day, temocapril 2 mg/day, or combination therapy with both drugs. Urinary levels of L-FABP as well as 8-hydroxydeoxyguanosine (8-OHdG) and protein excretion were measured before and after 3 months of treatment. The chronicity index and activity index were also assessed by histopathologic findings. RESULTS: Urinary levels of L-FABP and 8-OHdG were higher in patients with IgA nephropathy than in age-matched and sex-matched healthy controls (122.5 +/- 25.5 v 6.4 +/- 3.8 mug/g.creatinine, P < .001; and 22.6 +/- 4.4 v 4.8 +/- 1.4 ng/mg.creatinine, P < .01, respectively). Urinary levels of L-FABP were correlated with those of 8-OHdG (baseline, P = .0001; after 3 months, P = .008) and the severity of proteinuria (baseline, P = .0015; after 3 months, P = .0001). The percent reductions in urinary levels of L-FABP and 8-OHdG, protein excretion, and activity index after 3 months were greater in the combination therapy group, compared with each monotherapy group of olmesartan (P < .05) and temocapril (P < .05). CONCLUSIONS: The data suggest that a combination therapy of ARB plus ACEI has a greater beneficial effect on renal injury compared with monotherapy using ARB or ACEI in normotensive patients with IgA nephropathy.     

心型脂肪酸结合蛋白、肌钙蛋白Ⅰ与急性冠脉综合征冠状动脉病变程度的相关分析

目的探讨心型脂肪酸结合蛋白（H-FABP）、肌钙蛋白Ⅰ（cTnⅠ）与近期发作急性冠脉综合征（ACS）的患者冠状动脉病变严重程度的相关性及原因分析。方法ACS患者于发作12h内入院，1周内行冠脉造影者98例入选，其中急性心肌梗死（AMI）21例、不稳定型心绞痛（UAP）77例。采用双抗体夹心ELISA法定量测量待测血清H-FABP、cTnⅠ；根据关国心脏病协会所规定的冠状动脉血管图像记分分段评价标准，对病变狭窄程度进行分度、累及血管支数计算，采用Gensini积分系统，对冠脉血管病变狭窄程度、病变部位、范围进行定量评定；用卡方检验分析血H-FABP、cTnⅠ与狭窄程度、病变支数的相关性；采用二元回归分析方法分析血清H-FABP、cTnⅠ与患者冠状动脉病变严重程度的相关性。结果H-FABP≥8、0mg／L组与H-FABP〈8．0mg／L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异（P〈0．01）；cTnⅠ≥1、0mg／L组与cTnⅠ〈1．0mg／L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异（P〈0．01）；血清H-FABP、cTnⅠ与患者冠状动脉病变严重程度的二元线性回归方程：Y=15．664＋2．833x1＋1．034 x2（Y为Gensini积分，x1血中H-FABP浓度，x2为cTnⅠ浓度）；标准回归系数r为0．518和0．253（P〈0．01）。结论H-FABP、cTnⅠ与近期发作ACS的患者冠状动脉病变严重程度呈正相关，H-FABP与冠脉病变程度相关程度更高。血清H-FABP、cTnⅠ升高是冠状动脉病变急性加重的直接结果，临床可根据血清H-FABP升高推断冠脉病变的危险度并采取积极的治疗措施。     

Clinical significance of hyperglycaemia in acute coronary syndrome patients

Background: The clinical significance of moment measurements (admission and fasting glycaemia), persistent (hyperglycaemic index, HGI; time average glucose, TAG; mean glucose; maximum glucose) or chronic hyperglycaemia (HbA_1c, estimated average glucose, eAG) is still elusive in clinical practice.

Aim: To identify the clinical significance of hyperglycaemia in ACS.

Methods: The study included 226 consecutive patients with ACS. Indicators for hyperglycaemia were defined, calculated and a correlation analysis with standard parameters—EF, maximum CPK, maximum CPK-MB and troponin was performed. Patients were followed up for 12 months.

Results: Indicators for persistent and chronic hyperglycaemia correlated neither to ejection fraction, nor to the enzymes for myocardial necrosis (P > 0.05). In contrast, acute hyperglycaemia correlated negatively with ventricular systolic dysfunction (P = 0.001/0.007) and positively with maximum CPK, MB and troponin (P = 0.0001/0.008). TAG was an independent predictor for 6-month re-hospitalization (P = 0.027) because of cardiac complications.

Conclusion: Glycaemia at admission and fasting glucose could be used as metabolic surrogate markers for ventricular systolic dysfunction and TAG as an independent surrogate marker for six-month re-hospitalization. None of the indicators for hyperglycaemia could be used as independent prognostic factors for survival. Hyperglycaemia rather reflects an underlying impairment in glucose metabolism.     

心型脂肪酸结合蛋白、肌钙蛋白I与急性冠脉综合征冠状动脉病变程度的相关分析

目的探讨心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)与近期发作急性冠脉综合征(ACS)的患者冠状动脉病变严重程度的相关性及原因分析。方法ACS患者于发作12h内入院,1周内行冠脉造影者98例入选,其中急性心肌梗死(AMI)21例、不稳定型心绞痛(UAP)77例。采用双抗体夹心ELISA法定量测量待测血清H-FABP、cTnI;根据美国心脏病协会所规定的冠状动脉血管图像记分分段评价标准,对病变狭窄程度进行分度、累及血管支数计算,采用Gensini积分系统,对冠脉血管病变狭窄程度、病变部位、范围进行定量评定;用卡方检验分析血H-FABP、cTnI与狭窄程度、病变支数的相关性;采用二元回归分析方法分析血清H-FABP、cTnI与患者冠状动脉病变严重程度的相关性。结果H-FABP≥8.0mg/L组与H-FABP<8.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);cTnI≥1.0mg/L组与cTnI<1.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);血清H-FABP、cTnI与患者冠状动脉病变严重程度的二元线性回归方程:Y=15.664 2.833x1 1.034x2(Y为Gensini积分,x1血中H-FABP浓度,x2为cTnI浓度);标准回归系数r为0.518和0.253(P<0.01)。结论H-FABP、cTnI与近期发作ACS的患者冠状动脉病变严重程度呈正相关,H-FABP与冠脉病变程度相关程度更高。血清H-FABP、cTnI升高是冠状动脉病变急性加重的直接结果,临床可根据血清H-FABP升高推断冠脉病变的危险度并采取积极的治疗措施。     

测定Ⅱ型糖尿病患者尿视黄醇结合蛋白的临床意义

对１３４例Ⅱ型糖尿病患者尿视黄醇结合蛋白、白蛋白、葡萄糖排泄及肌酐清除率（Ｃｃｒ）进行了检测，结果显示：①１３４例Ⅱ型糖尿病患者中，３９例（２９．１％）２４小时尿视黄醇结合蛋白（２４ｈｒＵＲＢＰ）排泄增加，其增高的发生率随尿白蛋白排泄增加而增加；正常、微量及大量白蛋白尿患者，其２４ｈｒＵＲＢＰ增高的发生率分别为１１．４％、４３．６％及７７．８％；②在微量及大量白蛋白尿患者中，２４ｈｒＵＲＢＰ增高者与２４ｈｒＵＲＢＰ正常者相比，Ｃｃｒ显著降低（Ｐ＜０．０５）。结果提示Ⅱ型糖尿病患者肾小管间质损害亦相当常见，并与肾功能减退有关。     

蛋白芯片法联检急性冠状动脉综合征患者血中细胞因子的意义

目的 探讨急性冠状动脉综合征(ACS)患者血中炎性细胞因子、炎性细胞相关因子及心肌损伤因子浓度的变化及临床意义.方法 运用蛋白芯片技术同步联检经冠状动脉造影及临床表现证实为ACS患者104例及对照者50例血清或血浆中10种细胞因子水平;同时对不稳定性心绞痛(UA)患者按Braunwald分级进行分析.结果 急性心肌梗死(AMI)组和UA组血清中C反应蛋白(CRP)、白介素(IL)-6、可溶性CD40L(sCD40L)、基质金属蛋白酶(MMP)-9、心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白Ⅰ(cTnⅠ)及血浆中的IL-8、内皮素(ET)-1、可溶性血管细胞黏附分子(sVCAM)-1、氨基酸N末端脑钠肽原(NT-proBNP)浓度高于对照组,差异有统计学意义(P＜0.01);AMI组cTnⅠ[(11.08±10.49) μg/L]和H-FABP[(19.80±4.60)μg/L]浓度高于UA组[cTnⅠ:(0.69±0.18)μg/L,H-FABP:(4.12±2.45)μg/L,P＜0.01],而CRP、IL-6、MMP-9、sCD40L及ET-1浓度,两组比较差异无统计学意义;UA组MMP-9、sCD40L及H-FABP的浓度与Braunwald分级存在显著正相关(分别r=0.653,r=0.745,r=0.933,均P＜0.01).随着心绞痛严重程度的增加,MMP-9、sCD40L及H-FABP水平明显升高,心绞痛Ⅰ级＜心绞痛Ⅱ级＜心绞痛Ⅲ级(P＜0.01).结论 ACS患者血中存在多种细胞因子浓度异常,其中MMP-9、sCD40L、H-FASP的浓度与UA患者心绞痛严重程度存在良好的相关性.提示上述细胞因子参与和促使了ACS的发生、发展,为ACS的危险分层、预后判断提供了可能的分子标志物依据.     

急性冠脉综合征患者外周血MMP-2、MCP-1的检测及意义

目的 研究基质金属蛋白酶-2(MMP-2)、单核细胞趋化蛋白-1(MCP-1)在不同类型冠心病(CHD)患者血清中的水平及其临床意义.方法 急性心肌梗死(AMI)组24例、不稳定性心绞痛(UAP)组26例、稳定性心绞痛(SAP)组17例,另选同期20例冠状动脉造影(CAG)正常者为对照组.采用酶联免疫吸附法(ELISA)测定血清MMP-2、MCP-1水平.按Gensini评分标准对CAG结果进行评分.结果 MMP-2及MCP-1在AMI组、UAP组均显著高于SAP组及对照组.ACS患者血清MMP-2与MCP-1水平呈正相关(r=0.446,P<0.05),MMP-2、MCP-1水平与Gensini积分无相关性(P>0.05).结论 ACS患者血清MMP-2、MCP-1水平明显增高,可作为ACS发病和冠脉病变不稳定严重程度的预测因子.     

L/N-type calcium channel blocker cilnidipine reduces plasma aldosterone, albuminuria, and urinary liver-type fatty acid binding protein in patients with chronic kidney disease

Cilnidipine inhibits both L- and N-type calcium channels and has been shown to dilate efferent arterioles as effectively as afferent arterioles. We conducted an open-label, randomized trial to compare the effects of cilnidipine against those of amlodipine on blood pressure (BP), albuminuria, and plasma aldosterone concentration in hypertensive patients with mild- to moderate-stage chronic kidney disease. Patients with BP ≥130/80 mmHg, an estimated glomerular filtration rate of 90–30 ml/min/1.73 m², and albuminuria ≥30 mg/g, despite treatment with the maximum recommended dose of angiotensin II receptor blockers, were randomly assigned to two groups. Patients received either 10 mg/day cilnidipine (increased to 20 mg/day; n = 35) or 2.5 mg/day amlodipine (increased to 5 mg/day; n = 35). After 48 weeks of treatment, a significant and comparable reduction in systolic and diastolic BP was observed in both groups. The percent reduction in the urinary albumin to creatinine ratio and liver-type fatty acid binding protein (L-FABP) in the cilnidipine group was significantly greater than in the amlodipine group. Although plasma renin activity did not differ between the two groups, the plasma aldosterone level was significantly decreased in the cilnidipine group. Cilnidipine therefore appears to reduce albuminuria, urinary L-FABP, and plasma aldosterone levels more than amlodipine, and these effects are independent of BP reduction.